A review of bacteriophage therapy for Pseudomonas aeruginosa infections

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https://hdl.handle.net/2144/31229

Abstract

With the spread of antibiotic resistance, alternative treatment methods for bacterial pathogens are needed. Pseudomonas aeruginosa is a Gram negative, opportunistic pathogen that is a common cause of healthcare associated infections and is listed as a critical priority for research and development of treatments by the Centers for Disease Control and Prevention. P. aeruginosa poses an increased risk to patients within the surgical or intensive care unit, patients with indwelling catheters, cystic fibrosis, and burn wound victims. With a paucity of antibiotics in the pipeline for Gram negative bacteria, phage therapy has reemerged as a potential treatment option. Bacteriophages were first discovered in 1917 by Felix d’Herelle, but by the end of World War II, they were all but forgotten in favor of antibiotics. Eastern European countries and the former Soviet Union continued to develop phage therapy since its discovery, but studies were not on par with today’s standards. Recently the idea of phage therapy has reemerged in the Western world due to antibiotic resistance. In vitro and in vivo studies have shown that bacteriophages are easily isolated from the environment, with P. aeruginosa specific phages commonly found in hospital waste water and in sewage. Phage therapy has shown to be very effective at treating planktonic and biofilm forms of antibiotic resistant P. aeruginosa in vitro and in vivo. In humans, clinical trials are limited but phage therapy has successfully treated chronic otitis infections caused by P. aeruginosa and other studies have demonstrated the safety of phage therapy, reporting mild, if any, adverse effects. Bacteriophages may also synergize with several antibiotics, suggesting it may be beneficial to use them in conjunction to treat difficult or chronic infections. Additionally, P. aeruginosa bacteriophages may be beneficial in prophylactic treatment as well. When phages were combined with chlorine, a significant decrease in P. aeruginosa counts in chronic biofilms was observed, while also reducing its ability to form new biofilms. Similar results were noted when phages were applied to the lumen of catheters. These early results are promising for the future, but there are many steps that must be taken before starting new clinical trials and the widespread use of phage therapy begins.